The Healthy Development Measurement Tool

1. The Healthy Development Measurement Tool Rajiv Bhatia, MD, MPH San Francisco Department of Public Health

2. Presentation Objectives • Understand the background and structure of the Healthy Development Measurement Tool • Review an HDMT “application” • Consider How the HDMT can serve as a template for indicator systems for HIA in other contexts

3. Eastern Neighborhoods Rezoning = SFDPH HIA Policy Opportunity • City implements a rezoning and community planning process in the Eastern Neighborhoods responding to demand for housing and concerns about gentrification and displacement of low-income and minority communities • Community places demands on planning department to analyze plans impacts on social and health needs • SFDPH agrees to facilitate a health impact assessment of the Eastern Neighborhoods rezoning as an alternative, parallel process that considers community impacts • Researched and adopted best practices in community participation in planning and decision-making processes

4. SFDPH Land Use Planning Objectives • Identify and analyze the likely impacts of land use plans and zoning controls on health determinants. • Provide recommendations for land use policies and zoning controls that promoted community priorities. • Develop capacity for inter-agency working relationships. • Demonstrate the feasibility of health impact assessment methods. • Promote meaningful public involvement in land use policy-making by making explicit competing interests and facilitating consensus.

5. Known Public Health Impacts of the Built Environment • Physical activity • Pedestrian injuries • Asthma and respiratory disease • Obesity and chronic disease • Crime and violence • Social capital and cohesion • Child psychosocial development • Elder health and mobility • Water quality and quantity • Depression and isolation • Health disparities

6. Eastern Neighborhoods Community Health Impact Assessment • Collaborative, consensus-based health impact assessment to analyze how development in three SF neighborhoods affected health • Facilitated by SFDPH & Guided by a Community Council Comprised of >20 organizations and government stakeholders • 18-month process culminated in the development of the “Healthy Development Measurement Tool”

7. ENCHIA - Process • Phase 1. Created Healthy City Vision • Phase 2. Developed Community Health Objectives to reflect Healthy City Vision • Phase 3. Identified Community Health Indicators to measure Vision and Objectives • Phase 4. Generated Data Profiles on selected indicators to assess neighborhood conditions • Phase 5. Developed a menu of Policy/Strategy Briefs to advance Objectives • Phase 6. Created the Healthy DevelopmentMeasurement Tool (HDMT)

8. From Vision to Indicators: Creating a local framework for healthy built environment • Built Environment Elements that affect health: • Land use and zoning • Transportation systems • Community design • Housing • Public infrastructure

11. Modeled Vehicle Source PM 2.5 Concentrations At Streets – Southeastern San Francisco, CA

16. Aggravated Assaults and Alcohol Outlets

22. Healthy Development Measurement Tool (HDMT) – Overview • Goal: To support comprehensive and health-responsive planning using a systematic and objective method • Method:Multi-objective, voluntary evaluation metric and checklist that incorporates measurable community health indicators and development targets

23. HDMT – Components • Six elements of a healthy city • Community health objectives • Measurable indicators and baseline data • Action Targets for Land Use Development • Health-based rationales • Policy and strategy recommendations

24. HDMT – Organization

25. HDMT Elements

26. HDMT Community Health Objectives

27. Objective pages include: • Indicator pages with associated data to advance the Objectives • Development Targets that provide criteria to evaluate the healthiness of a Plan • Health Based Rationales linking the Objectives to public health • Established Standards (City, State, and/or Federal) that relate to the Objective • Policy and Design Strategies that can be applied to improve a plan or project

28. Indicator pages include: • Indicator data in the forms of maps and tables often disaggregated by neighborhood • Explanations and Limitations of the data • Research connecting the indicator to health

29. HDMT Application Example: Executive Park SubArea Plan (EPSP)

30. Application Process • Does a place have healthy living and working conditions? • Use HDMT indicator data to assess and record baseline conditions • Does a plan or project advance health-related conditions? • Review plan or project documents to assess the extent to which it meets HDMT development target? • What recommendations for planning policies, implementing actions, or project design would advance community health objectives? • Identify or develop concrete and specific recommendations for plan/project improvements

31. Gathering Existing Data • Project/plan Documents: • Newspaper articles • Conducted 4 site visits / assessments • Attended 3 community planning meetings • Conducted 5 key informant interviews (in-person and phone)

32. Defining Geographical Scope

33. EPSP Application Example (Step 1) Does a place have healthy living and working conditions? • Step 1: Use HDMT indicator data to assess baseline conditions • Indicator PI.6.a: Proportion of population within 1/2 mile from full-service grocery store/supermarket

34. EP SubArea Plan Example (Step 1) • Indicator PI.6.a: Proportion of population within 1/2 mile from full-service grocery store/supermarket

35. EPSP Application Example (Step 2) Does a plan or project advance health-related conditions? • Step 2: Review plan or project documents to assess the extent to which it meets HDMT development targets

36. EPSP Application Example (Step 3) • What recommendations for planning policies, implementing actions, or project design would advance community health objectives? • Step 3:Identify or develop concrete and specific recommendations for plan/project improvements

37. HDMT – Development Checklist

38. HDMT – Applications • San Francisco • Executive Park Sub Area Plan • Eastern Neighborhoods Area Plans • Bernal Height Preschool Planning • Western SOMA Community Plans • Daggett Place Project • Beyond San Francisco • Humboldt County General Plan Scenarios • Richmond California General Plan • Oakland Estuary Plan • Geneva Agglomeration Plan

39. HDMT – Limits • Does not regulate actions or force compliance • Does not provide for in-depth or scientific forecasting of impacts • Action targets and mitigation strategies oriented to Urban mixed-use development

40. What the HDMT Contributes • Responds to a lack of formal mandates to consider health in planning • Provides a “systems view” for analyzing policy and projects on the inter-related issues of sustainability, economy, community, population and health • Provides indicators for existing conditions, impact analysis and monitoring • Helps to reveal relationships among issues and make explicit trade-offs • Build inter-agency relationships and increases transparency of decision-making processes • Template for tool for other contexts and policy domains

41. HDMT and Alaska HIA • Process for developing consensus vision and objectives for healthy development of natural resources • Template for indictor system for assessing existing conditions • Consolidated public resource for HIA with health conditions data, project information, mitigation strategies, etc